Diagnosing serious child abuse

BMJ 1999;318:462 ( 13 February )

Letters

Diagnosing serious child abuse

Death from Munchausen syndrome by proxy is overestimated

Authors' reply

All healthcare team members should be alert to indicators of child abuse

Death from Munchausen syndrome by proxy is overestimated

The first 150 words of the full text of this article appear below.

EDITOR $---$ Jones and Lynch¹ have made mistaken claims, purportedly drawn from the epidemiological study by McClure et al.²They failed to notice that the study collected data on non-accidentalpoisoning and non-accidental suffocation as well as Munchausensyndrome by proxy. They say that McClure et al identified 128cases of "factitious illness by proxy." The actual figure was97; 128 is the global figure. They also say that eight childrendied from Munchausen syndrome by proxy. Again this is a globalfigure, and closer reading of the study shows these cannot allhave been from Munchausen syndrome by proxy, and in fact onlyone of them may havebeen.

The study took the convening of a first case conference for suspected abuse as confirmation of a diagnosis of Munchausen syndromeby proxy. Case conferences are not called for a dead child. Therefore,for a death from Munchausen syndrome by proxy . . . [Full text of this article]

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Diagnosing and responding to serious child abuse: David P H Jones and Margaret A Lynch
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